If you're one of the lucky ones heading off to Mexico or some other warm Central American or Caribbean country this break, this information is for you. One study reported that 29 percent of American college students develop travelers' diarrhea (TD), which is more fancifully termed "Montezuma's Revenge." Here are some suggestions for how to keep yourself healthy, and what to do if you do come down with TD.
What is travelers' diarrhea?
Travelers' diarrhea is a food-borne illness that can also involve nausea, vomiting, and fever. TD usually lasts from three to five days, and is usually self-limited and not life threatening. It is caused by consuming foods or drinks that have been contaminated with pathogens, most often bacteria, such as E.coli or salmonella, but also viruses and parasites.
How To Prevent Travelers' Diarrhea
- Wash your hands often with soap and water. Also, bring along a pack of antibacterial hand wipes, such as Wet Ones, or alcohol swabs.
- Drink only bottled or boiled water, carbonated drinks in cans or bottles, coffee, tea, beer, or wine. Avoid tap water, fountain drinks, and ice cubes. Wipe off the top of the can or bottle.
- Eat only thoroughly cooked food, pasteurized dairy products, and fruits and vegetables you have peeled yourself. No salads.
- Don't eat food purchased from street vendors.
- In areas where water is contaminated, don't brush your teeth with tap water.
- Don't swim in fresh water. Salt water is usually safer.
- Yogurt and probiotic pills containing live acidophilus cultures (the "good" gut bacteria) have the potential to help prevent TD by keeping lots of the "good" bacteria in your gut to give any invading "bad" bacteria some competition, but they have not been proven to help.
- Prophylactic antibiotics can be discussed with your doctor. Studies have reported that certain antibiotics can help prevent bacterial-caused TD. However, their use is not without risks, such as allergic reactions, hypersensitivity to the sun, and increased susceptibility to yeast infections. Also, overuse of antibiotics is increasing the number of antibiotic resistant strains of bacteria throughout the world. In general, prophylactic antibiotic use is only recommended for those with compromised immune systems. If you do decide to take antibiotics to prevent TD, don't think you can eat and drink whatever you want. The pathogen may not be a bacterium, or, if it is, it may be resistant to the particular antibiotic you're taking.
What Doesn't Work for Prevention
Some products advertised to help prevent TD can actually do more harm than good. Difenoxine, the active ingredient of diphenoxylate (Lomotil), actually increases the incidence of TD. Activated charcoal and antiperistaltic agents, such as Imodium and Lomotil, are ineffective at preventing TD.
How To Treat Travelers' Diarrhea
If you have the unfortunate experience of getting TD, there are several steps you can take to diminish its symptoms and hasten your recovery.
- Take Pepto-Bismol, or a similar product containing the active ingredient bismuth subsalicylate, (two ounces four times a day, or two tablets four times a day). Possible side effects of this large dose of Pepto-Bismol include black stools, nausea, and constipation. You should not follow this regimen for more than three weeks. Avoid aspirin while taking a bismuth subsalicylate product. Also, children and adolescents who could have the chickenpox or the flu should not take either aspirin or bismuth subsalicylate because of the danger of Reyes' syndrome.
- Yogurt and probiotic pills containing live acidophilus cultures (the "good" gut bacteria) have the potential to help TD by giving the "bad" bacteria some competition, but they have not been proven to help. Since dairy products can aggravate diarrhea, the probiotic acidophilus pills might be the better way to go.
- The most important treatment for travelers' diarrhea is replacement of fluids and salts. Because TD is so common in Latin America and other developing countries, oral rehydration solutions, such as the World Health Organization oral rehydration salts (ORS), are available in many stores and pharmacies. These packets of salts should be mixed with safe water and taken as directed.
What Doesn't Work for Treatment
- Various absorbents, such as activated charcoal, and thickeners, such as Kaolin and pectin, don't work.
Is It Worth the Risk?
Of course it is! Who wouldn't risk a bout with diarrhea in order to lie on a beach in the sun and swim in the warm Caribbean Sea? Just take some common sense precautions and you'll have a wonderful time. Talk to your family and your doctor about your trip. Whether or not you decide to take preventive antibiotics, or just bring them along in case the "Revenge" hits, keep any medicine in the original container to avoid hassles with customs agents. Pack some wet wipes and some Pepto-Bismol, and you're all set.
